Healthcare Provider Details

I. General information

NPI: 1649270406
Provider Name (Legal Business Name): SUZANNE M BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ENTERPRISE DR
AUGUSTA ME
04330-7997
US

IV. Provider business mailing address

15 ENTERPRISE DR
AUGUSTA ME
04330-7997
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-1880
  • Fax: 207-621-1881
Mailing address:
  • Phone: 207-621-1880
  • Fax: 207-621-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA001206
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: